Learn About Your Options for Colorectal Cancer Screenings

Colon, or colorectal, cancer is one of those things people don’t like to talk about. However, it deserves your attention and time given it’s the third leading cause of cancer-related deaths in both American men and women, and it’s expected to cause about 52,550 deaths during 2023.

Despite those frightening statistics, there is a bit of good news around colon cancer. And that is this: colon cancer is highly treatable and often curable. Thanks to enhanced screening options that detect polyps before they can develop into cancer, death rates from colon cancer have been steadily dropping over the past several decades.

Currently, the American Cancer Society recommends that people at average risk of colon cancer start regular screenings at age 45. Screenings can be performed with a sensitive test that looks for signs of cancer in a person’s stool, or with a visual exam (colonoscopy) that looks at the colon and rectum.

Assuming you’re in good health and your initial screening raises no red flags, you should continue screenings once every 10 years at least until the age of 75, or even up to 85 if appropriate. Again, these recommendations are for individuals at average risk.

The most common risk factor for colon cancer is age. In fact, more than 90% of cases of colon cancer are diagnosed in individuals 50 years of age and older.

Factors that might warrant getting screened before the age of 45 include:

• A personal history of colorectal cancer or certain types of polyps 
• A strong family history of colorectal cancer or certain types of polyps
• A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
• A confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC)
• A personal history of getting radiation to the abdomen (belly) or pelvic area to treat a prior cancer

In addition, there are several risk factors that you have the power to change. These include lifestyle issues, such as:

• Smoking         
• Being overweight or obese
• A diet rich in red meats, processed meats, and fat
• Heavy alcohol use
• Not being physically active

Again, thanks to advances in screening technology, you now have options: a stool-based test or a colonoscopy.

Stool-based tests are often preferred as they can be done at home. Using a mail-in kit, they involve collecting and sending stool (feces) samples off to a lab to be examined for possible signs of colorectal cancer or polyps. While the at-home option is nice, these tests are not perfect. They can miss polyps and precancerous growths in the colon that should be removed. They may even provide false-positive test result. Plus, they need to be performed more often than visual exams (every 1-3 years v. every 10) and, if the results come back positive/abnormal, a colonoscopy will need to be performed.

As for colonoscopies, they do require performing a bowel prep the night before your procedure, and typically require arranging transportation home from your procedure due to use of a sedative given to you during the colonoscopy. During the roughly 30-minute procedure, your doctor will visually assess your entire colon using a flexible tube with a camera on the end. If any small polyps are detected, they may be removed during the procedure. Any polyps removed will be sent to a lab to check for cancer. Similarly, tissue may be removed from larger polyps or other unusual growths too large to be removed during the colonoscopy. That tissue will also be sent to a lab for testing.

As for which option is right for you, that’s a discussion you should have with your doctor. Whatever you choose, the most important thing is to simply get screened.

 Dr. David Furman is a gastroenterologist at Southwestern Vermont Medical Center.